Book reviews

F time immemorial, soldiers, politicians, officeholders, and other functionaries who ended their careers under a cloud of public opprobrium have seen fit on leaving office to write an “apologia”—not to be confused with “apology,” an expression of regret over admitted failure. An apologia rather is a defense, usually based on detailed explanation, evidence, and argument, of the author’s beclouded career. Perhaps the most famous instance was English Cardinal John Henry Newman’s Apologia pro Vita sua (1864), which attempted to vindicate his conversion late in life from the Church of England to Roman Catholicism and which is now recalled as one of the greatest prose masterpieces in the English language. Certainly no stigma attaches to writing an apologia. Any public person whose actions and character have been broadly impugned deserves the right to make a considered public reply. An instance of such a reply inviting comparison with Secretary of Defense Donald Rumsfeld’s Known and Unknown is former Secretary of Defense Robert McNamara’s In Retrospect (1995), in which he owned up to his failure to divulge his growing reservations concerning the Vietnam war to President Lyndon Johnson. Though McNamara’s book is nominally an apology, it is clear that he was still nursing wounds from the savaging he endured at the hands of Vietnam war critics and was hoping to rehabilitate his place in history by portraying his war decisions in a more nuanced and sympathetic light. Ironically, the appearance of his book some 30 years after the events served little more than to awaken and re-vocalize his critics. I mention his book to illustrate that authors can and do mix artful apology into their apologia as a deliberate rhetorical technique. By admitting to venial mistakes, they hope to gain credibility later in defending their whoppers. In Rumsfeld’s apologia for his stewardship of the Pentagon during the first six years of the George W. Bush administration, he elevates the device of the self-serving admission of minor error into a high art form. One example of many: “I soon learned that my ‘old Europe’ comment had touched a raw nerve. It caused an uproar, especially from those who felt they were on the receiving end of my remark. The French Finance Minister called the comment ‘deeply irritating.’ Ironically, my comment was unintentional. I had meant to say France and Germany represented ‘old NATO,’ not ‘old Europe.’” New York: Sentinel, 2011

there is much difference between practice and study; and though, without doubt, every person who undertakes the treatment of a single disease s(hould be regularly educated, yet, by confining his practice to a single object, he cannot but become better informed in whatever relates to it.
In the operative branches of surgery, this is particularly desirable: because practice only can render the operator cool under, and prepared for, every difficulty, as well as ready under all circumstances. In the nicer operations, this is particularly necessary. Nothing but frequent early opportunities can, in our opinion, fit a person advanced to the full strength of Lis judgment, to undertake the extraction of the cataract.
The remainder of the preface gives an account of the manner in which the translation has been conducted ; every part of which will be approved by the reader.
The author's preface follows, which relates principally to the manner in which he has conducted the work, and his reasons for undertaking it.
The first Chapter is of the puriform discharge from the palpebra?, and of fistula lachrymalis. The exordium gives us a very favourable impression of the professor's accuracy. He distinguishes between a small quantity of pus, which appears at the puncta lachrymalia, and the true fistula lachrymalis. The first he very properly calls a puriform state of the via lachrymalis,* arising from such a discharge along the palpebrse, which finds its way to the orifice of the duct, and may be pressed back. This may give a suspicion that the duct itself is diseased, and the surgeon may have the credit of curing fistula lachrymalis with very little trouble. The true fistula lachrymalis is next described, and the mode of treatment is very judicious. Some of the remarks may be called new, even in this country, where the subject has been so often and so nicely examined.
Some useful cases are added to illustrate the whole.
The second Chapter is on the hordeolum, or stye. This the author distinguishes from the small abscess, which sometimes occurs in those parts, by remarking, that the contents, instead of being purulent, consist wholly of dead matter. The mode of treatment in its different stages, is such as is familiar with most practitioners.
The third Chapter comprehends incysted tumours of the eyelids. This is a very important subject, and we cannot help admiring the candour of the author, in acknowledging that he has never been able to resolve these tumours by any of those applications which have been solnuch extolled by others; nor, indeed, by any other means, after they had arisen to such a size as to determine their real character. He therefore considers, that extraction is the only remedy, which should be attempted as early as possible, O o 2 that * In the translation it is " via lachryTnalia." We know not how such an ^accuracy of the printer could have been overlooked. , that the operation may be the more easy to the patient. The reader will recollect, that this impossibility of treating such tumours, in the same manner as any other diseases, induced Dr.
Adams to consider them as possessing all the properties of hydatids, in consequence of which the cyst, having an ceconomy peculiar to itself, could not partake of those actions by which diseased parts, particularly the capsules of abscesses, are absorbed, or so altered as to return to . their former organization. The professor, with much judgment, contents himself with stating the facts as they have occurred, without engaging in the controversies of others, or any theories of his own. Chapter IV. is of the cilia, which irritate the eye. This chapter contains much new matter, related with an accuracy such as we might expect from the author. distension and oedema, and induces a. relaxation of them, by which the cartilaginous holder of the eye-lid ultimately losing a proper and firm support in the integuments, inclines towards the eye-ball, and afterwards turns inwards, and draws the cilia along with it in the same improper direction. The same unpleasant effect, independently of the relaxation of the integuments, is frequently produced by a softening of the cartilage of the tarsus, in consequence of a copious and long continued puriform discharge from the ciliary glands, by which the cartilage of the tarsus becomes either ?wholly or partially incapable of supporting itself erect, or of preserving the curve necessary to its perfect coaptation with the tarsus of the other eye-lid: hence the cartilage, either in the whole, or a part of its extent, becomes relaxed and folded inwards, and draws along with it the corresponding hairs against the ball of the eye. " These causes are not unfrequcntly found combined together, and they are also often accompanied with cicatrices of the membrane which invests the internal margin of the tarsus. Some* pretend that the trichiasis is occasionally produced by a spasmodic contraction of the orbicularis palpebrarum. But I must confess that this has never come under my own observation, and it is difficult to believe that the spasm of this muscle, however violent, can produce a folding inwards of the tarsus and cilia, much less that it should continue to act as a permanent cause of the disease. " The degree of uneasiness which must necessarily result from the hairs perpetually pressing upon the cornea and white of the eye, may be easily calculated even by those who arc little acquainted with surgery. To aggravate this evil still more, it very frequently happens, that the hairs bent inwards acquire a much greater length and thickness than those which retain their natural position. And although the disease bo confined to one eye, yet from consent, both are usually affected, and the sound eye cannot be moved without occasioning pain in that which is subjected to the irritation and friction of the inflected hairs. In general, it may be said, that both the eyes in persons affected with this disease arc very irritable and impatient of the light. As the patient, in cases of incomplete trichiasis, retains some little power of opening the eye-lids for the purpose of seeing, and that most frequently towards the internal angle of the eye, the head and neck are frequently inclined in an aukward manner, producing in children, at length, a distortion of the neck and shoulders, which is with difficulty corrected, even after the trichiasis is cured. Children besides, impatient of the irritation which the inflected cilia produce, are incessantly rubbing the eye-lids, which contributes in no small degree to increase the evils consequent on the trichiasis ; such arc the varicose chronic ophthalmia, the nebula, and the ulceration of the cornca." The * Bell's System of Surgery, vol. iii. p. 27C.
Mr. Briggs, on Diseases of tin Eyes.

5G7
The cure proposed for the second /pecies of Trichiasis is, by an excision of the under portion of th<^ skin close to the edge of the eye-lid, so that the contraction formed by the future cicatrix may give the cilia? a different inclination. The operation and subsequent treatment are well described, and the remedies against the other diseases explained with the same accuracy: the chapter concluding, like the rest, with some well selected cases. The next chapter, of the relaxation of the upper eye-lid, is equally judicious, the various causes well pointed out, and a proper distinction made between the disease when arising from a paralytic state, or too great elongation of the lid, and when only a symptom of other complaints. In the first case, the remedy proposed is similar to that for trichiasis.
Chap. VI. is of the eversion of the eye-lids. This disease, of course, arises from causes directly opposite to the former. The remedies proposed by the Professor arc extremely simple, which is no inconsiderable recommendation, as they are not less judicious.
Chapter VII. begins the subject of Ophthalmia. This is divided into chronic and acute, and shows, with much force, the necessityof this dcscrimination, the remedies for each being diametrically opposite. The favourite remedy first recommended by Mr. Ware, the tinct. thebaica of the old pharmacopoeia, is said to be not less injurious in the acute than serviceable in the chronic, or which is often the same thing, highly serviceable in the progress of a disease, which it has exasperated at the beginning. of Professor Scarpa with the utmost deference,yet I cannot help oil" tertaining some doubts of the propriety of assigning the gonorrhoea as a cause of ophthalmia; since, during a pretty extensive experience of twenty-five years, I have never seen one single instance of an inflammation of the eyes, which was evidently derived from a gonorrhoea. I am sufficiently aware of the nature and force of negative evidence in matters depending on testimony, not to ?vcr-rfctc it; and certainly, to deny the existence of any attested fact, merely because it has not occurred in the course of a man's own experience, would be hasty and unjustifiable. In the instance now before us, there are two points to be considered; the testimony of a respectable Professor, and the validity of his opinion; for it is not only asserted, that those who are infected with a gonorrhoea may be attacked by a violent ophthalmia, but that the gonorrhoea i? somehow or other the cause of that ophthalmia. It is with reference to the latter proposition that I express my doubts, which An Introduction, by the translator, informs us, that the author was originally destined for medicine, but acquiring a fondness for iiatural history, by his acquaintance with the celebrated liuffon, by whom he was employed in his dissections for comparative anatomy, his whole attention was afterwards directed to those enquiries. An attention to his health, however, induced him to examine into the disease here treated ot ; and by great attention, he discovered a remedy, which he could have no motive in recommending, but public utility. It is lurther remarked, in favour of the proposed remedy, that the author lived to the age of eighty-four; and" lastly, that the translator has found every practical advantage he could expect, from the information cofitained in the work The work itself begins with a division of the life of man into Various periods, marking, more particularly, those in which the different organs (particularly the stomach) begin to decline in the proper exercise of their functions. After this, we have a description of the effects of indigestion ; among the rest, the evolution of air; to which, it ife well known, that the French impute most of those diseases, which in England are now commonly called nervous.
The various kinds of food are next enumerated, as they are subservient to the nourishment of the inferior animals and of man.
Here we are informed, that the peasantry, if not obliged to labour too hard, and have sufficient clothing, enjoy health and strength, with a diet consisting principally, if not entirely, of vegetables; whilst the more wealthy, whose food is composed of every thing that they can obtain, though apparently in higher health, arc subject to a variety of diseases, which excreise only can prevent or relieve. Even this*, however, joined to a more sparing indulgence, will rarely be sufficient; so that, 011 the whole, the author conceives vegetable substances the proper food for man.
His argument, on this occasion, is somewhat obscure; but as far as we can understand him, it appears his opinion, that it is necessary the stomach should be distended to a certain degree, and, that if this distention is occasioned by animal food, the consequence will be, a quantity of nutritious matter greater than the constitution can dispense with. It is not our intention to comment on this, or other physiological errors, which appear to us in the work; it is enough, that the remedy was found practically ueful, in which there is no reason to doubt the giidence of M. Daubenton, or his Translator. Octavo, pp. 36*8.
These subjects occupy a little more than half the volume; the remainder, which the author considers as more original, or containing more of novelty, comprises observations on amputation, on luxations, a discourse on fractures, on scalds and burns, in the treatment of which he prefers the refrigerating plan ; on ulcers, gunshot wounds, locked jaw, in the treatment of which he found opium dropped into the <?ars of essential service, and he suggests the propriety of trying the tinctura Jerri muriata in doses of twenty drops every ten minutes.
The volume concludes with the treatment of sphacelus or mortification, which the author justly considers as the most original and interesting part of his work. The improvement consists in applying nitre finely powdered to the surface of the wound, as our readers have already seen in this Journal. The success of the application of nitre suggested to us the propriety of trying the oxygenated muriate of potash in the same manner. This hint has been given to several surgeons, but we have not yet received any account qf its success^ We think Dr. C. has deserved well of the profession by this publication, and that surgeons in the army and navy in particular will tiud it well worthy of their attention. Dr. Coxe's American Dispensatory. 571 has been supplied so ably and judiciously by Dr. Coxe. The arrangement is alphabetical. All the useful tables of thermometers, specific gravity, solubility, affinity, &c. are given with great accuracy, and we congratulate the medical public on the acquisition of so correct and valuable a work.